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35-188 (4) WWI Troposa Vinyl Siding Corbett Home Improvement Roofing Northampton, MA 01060 Awnings (413) 584-6571 Canopies Gutters L► �O j 06O � Shutters PROPOSAL SUBMITTED TO PHONE 5— 6— /3L/7 IPATE / S 01/ S FREEl ,5- v �{�7 JOB NAME CITY,STATE,alsl ZIP CODE JOB LOCATION DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: eLWC U ,'V JIM �„-a L � _i sr re —x,)v,,i u Ltk' S we TrOpOSe hereby to furnish material and labor-complete in accordance with the above specifications,for the smu of: Dollars 0 Payments to be made as follows: n/d 6416Le ' �G�� VA 47-a 01je/J 40^0" All material is guaranteed to be as specified. All work to he c uipleted in a work-like manner according Authorized to standard practices. Any altercations or deviation from above specifications involving extra costs will be Signature " executed only upon written orders,and will become an extra charge over and above the estimate. All Note: This proposal may be agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire,tornado and other necessary insurance. Our workers are fully covered by Workmen's Compens ation Insurance. WI Idea a by us if not accepted within clays. 'keeeptanee of Troposaf-Tlte alxive prices,specifications are conditions are satisfactory and are hereby accepted.You are authorized to Signature do the work as specified. Pay�nI Zltjia le as outlined abve. e: /l Signature 'Ch�pT COQ`- O,y 9 6 �asackasctla' _ DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT with a principal place of business/residence at: 57 (phone (SU=t/city/=W2ip) E do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: (Insurance Company) (Policy Number) (Expiration Date) ( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Compairy/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional sheet if neecsary to 4whide info marion pertaining to all 000tracton) ( I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that while homeowners who employ pa-.ow to do ma%nt_ __M_._a■ wnstruceioa or repair work on a dvmlling of not moc o than three emits is which the homeowner resides or on the grounds appurtenant thereto arc not gc=Wly considered to be employ=under the vmd='s compensation Act(GL152,ss 1(5)�application by a homeowner for a license or permit may evideme the legal status of an employer under the Wodcar's Compomation Ara. I underatand that a copy of this ctatcmcat may be fmwwx ed to the Dcpwt=ot of Iodustrial Accidoa&Offioe of Imur—for the coverage verification and that failure to secure coverage under section 25A of MGL 152 can lead to the imposition of criminal penalties consisting of a fine ofup to$1,500.00 mWoe imprison of up to one year and civil penalties in the form of a Stop Work.Order and a find of S100.00 a day against tae. For dgxirtm=W use Only Permit Number —ef e -22 d/ Mao _Lot# Signature of icroseelpermitiee CTiON,8 'CpNSTRUCTION 5ERVICES 1 Licensed Construction Supervisor: pp Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone y� Not Applicable ❑ Regist tion Number Company Name -02, Ad ress Expiration Date Telephone _o SECTION:V!- .0..0RKER$',COMPENSATION.I.NSURANCE AFFIDAVIT(M.G1.c. 152,§25C(+5)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance f the building permit. igned Affidavit Attached Yes....... No...... ❑ The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780 Sixth Edition Section 108.3.5.1. Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the fob site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature lira e New House ❑ Addition ❑ Replacem4 Windows Alteration(s) ❑ Roofing ❑ Or Doors V Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ ] Brief Description of Proposed Work: l Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet❑ 1111or MAIM: 7w a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION Ila OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNS tS AGENT OR.CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under a pains and penalties of perjury. Print Name 3 -zz- p/ Signature of Owner/Agent Date Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ?YES_ No IF YES, describe size, type and location: / I City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 phone 413.587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SEC ION S;W14NIPORMATII;N Ae f , 1.1 Property Address: g s� iY6rz s „CTI©N,2 PI t PI RTY OYVNERSHIP/AUTHORIZtD AGENT 2.1 Owner of Record: Name(Print) Current Mai ng Address: Telephone Signature 2.2 Authorized Agent: �2 /""� Name(Print) Current Nfailing Address: Signature Telephone S'EGTf'ON 3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use,Only completed by ermit applicant 1. Building (a)Building;Permitfee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 +4 +5) Check Number This Section For Official Uie Onl' Iuilding Permit°Number: Date Issued; Signature: B.wilding,Corrrrr►issignerllnspectc�r Qf.Buifdings Date 54 SYLVESTER RD BP-2001-0746 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 35- 188 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category:windows replaced BUILDING PERMIT Permit# BP-2001-0746 Project# JS-2001-1402 Est.Cost:$3400.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Ed Corbett Jr 116069 Lot Size(sq.ft.): 19776.24 Owner: FLYNN BRENDAN J&MARYELLEN KA Zoning:RR Applicant: FLYNN BRENDAN J & MARYELLEN KA AT. 54 SYLVESTER RD Applicant Address: Phone: Insurance: 54 SYLVESTER RD FLORENCEMA01062 ISSUED ON:3122101 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Final: Final: Rough Frame: Gas Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy , Sienature: Fee Tyne: Receipt No: Date Paid: Check No: Amount: Building 3/22/010:00:00 1174 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo i 54 SYLVESTER RD BP-2001-0746 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:35=188 CITY OF NORTHAMPTON Permit: $uildn Categtrt ry:windows reolaccad BUILDING PERMIT Permit# BP-2991-9746 Proiect# JS-2001-1402 Est.Cost:$3400.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO Canst.Class: Contractor: License: use Gruup: Ed Corbett Jr 116069 Lot Sk;W.L): 197 ;6.24 Owner: gLym DubIi M J&MARYELLEN KA Zoning:RR AWd cant• FLYNN BRENDAN J & MARYELLEN KA AT: 54 SYLVESTER RD ApnlicantAd�/ress: Phone: lns�uranE 54 SYLVESTER RD FLORENCEMA01 062 ISSUED ON:31221010:40:00 TO PERFORM THE.FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS POST THIS CARD SO IT IS VISIBLE FROM THE STREET inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: Footings: Roughs- Rough: House# Foundation: Final: Final: Rough Frame: Gas Fire ftartment Fireplace/Chimney: Rough: iii: Insulation: Final: ftoke: Final: OK !f./3..a!4 ✓ THIS PERMIT MAYBE REVOKED BY THE CITY OF NORTHAMPT UPON VIOLA JON OF ANY OF ITS RULES AND REGULATIONS --�'` CeWfiggle of OcgMn Signature:' Fee Tvne: ReceiQt No: Date Paid: Check No: Amount: Building 3/22/010:00:00 1174 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patilio